Evaluation of a Diagnostic Therapeutic Educational Pathway for Asthma Management in Children and Adolescents

Abstract

Background: Limited evidence exists for the effectiveness of educational programs that improve pediatric asthma control in real-world settings. We aimed to assess the impact of a diagnostic, therapeutic, and educational pathway (DTEP) for asthma management in children and adolescents attending an asthma referral center.Methods: This is a retrospective population-based cohort study, including two groups of patients with asthma, aged 6-17 years and residing in the Local Health Authority (LHA) of Brescia, Italy: (a) the children who followed a DTEP (intervention group) and (b) all the children residing in the LHA who did not follow DTEP (control group). The incidence rates (IRs) of hospitalization, emergency room visit, use of outpatient services, and drug prescription for dyspnea, wheezing, or respiratory symptoms were computed for time before and after attending DTEP in the intervention group and for "early" and "late" time since asthma diagnosis in the control group.Results: There were 9,191 patients included in the study, 804 of whom followed DTEP. In the before-DTEP/early time, the intervention and control groups showed similar IRs for all the outcomes apart from emergency room visits (IRs of 138.6 and 60.3 per 1,000 person-years, respectively). The IRs decreased from before to after DTEP and from early to late time in both groups. The IR decrease for emergency room visits was significantly higher in the intervention than in the control group (−51.3 and −28.2%, respectively; IRR = 0.61, P = 0.001). Conclusion: The DTEP can increase patients' capability in managing asthma and preventing asthma attacks.

The experiences, perceptions and challenges of mothers managing asthma in their children: a qualitative study

“…38 Previously it was emphasized that establishing asthma action plans are necessary in order to minimize the problems of families. 24,[39][40][41][42][43] In conclusion, this is the first study that examines in detail the experience of mothers with children with asthma and the findings of the current study demonstrated the significant impact mothers emotional problems have on the parents' everyday life and the importance of health professionals' knowledge to identify and support mothers with these conditions. Acknowledging these experiences and their implications will improve interventions and support by health professionals as they assist families.…”

Impact of a Diagnostic Therapeutic Educational Pathway (DTEP) Self-Management Program for Asthma Management in Preschool Children

“…Several previous randomized clinical trials have shown not only that asthma control can be substantially improved by self-management training, a core component of which is patient education, but also that educational and behavioral interventions can achieve positive results in asthma control in children and adults (10,11). We have previously documented a favorable impact of our DTEP on asthma control and asthma-related outcomes among children and adolescents aged 6-17 years (12)(13)(14)(15)(16). Since no previous study had evaluated the impact of a Diagnostic Therapeutic Educational Pathway (DTEP) on asthma control among children of less than 6 years so far, the present study, to our knowledge, is the rst to do so.…”

“…The Center "Io e l'Asma" is an outpatient pediatric asthma center at the University of Brescia, which provides a Diagnostic Therapeutic Educational Pathway (DTEP), designed to obtain and maintain control of wheezing by focusing on child and family autonomy and relying on a strong collaboration between specialists and primary care physicians, where we organized several meetings to share the DTEP following the GINA guidelines, during the last fteen years (12)(13)(14)(15)(16).The DTEP consists of three specialist evaluations at the Center, with an 8-12 weeks' interval between them, and two follow-up visits at 6 and 12 months after the last evaluation. After each specialist's evaluation, the child is referred to his/her primary care physician for documenting the symptoms control by clinical evaluation and adjusting therapy for 6-8 weeks based upon the degree of wheezing and respiratory compromise.…”

“…In a series of previous publications, we described the successful diagnostic and therapeutic outcomes of patient management of adolescent and teen-age patients with asthma using a pediatric self-management program that we developed in Italy referred to as the Diagnostic Therapeutic Educational Pathway (DTEP) (12)(13)(14)(15)(16). The purpose of the present study was to evaluate the effectiveness of the DTEP in a cohort of younger preschool children with wheezing by comparing the frequency of wheezing-related outcomes before and after intervention with this patient self-management program.…”

Recommendations for diagnosis and anti-relapse treatment of bronchial asthma in preschool children

“…Однако такой подход может привести к диагностической ошибке: положительный или отрицательный ответ на лечение, не является надежным тестом, так как причины положительного ответа включают эффект плацебо (обычно очень высокий в исследованиях по ингаляционной фармакотерапии), естественную спонтанную изменчивость симптомов, наличие другого, отличного от БА кортикостероид-чувствительного респираторного заболевания. И наоборот, отрицательный ответ может быть связан с плохим соблюдением регулярной терапии, неверной техникой использования ингалятора или прогрессированием заболевания [7,8].…”